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fentanyl withdrawal after 36hrs.

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Posted 10/24/2014 6:35 AM (GMT 0)
confused I have been on 200mcgs. patch for close to 3 yrs. moved to 250mcgs, 6 months ago. Moved to around a 7 to the good on the pain scale but struggled to make 72 hrs. When I asked for the raise he ok'd it and said to move to 300mcgs. I thought I dont think I need 100mcgs. so I went to 250mcgs. instead.When I made the raise to 250 I got a little better relief but struggled to make the 72 hrs.At about 62 hours I could start into withdrawal. Anyway so I moved to 300mcgs. after being on 250mcgs. for a little over 6 months. A week later and now waking up in withdrawal state after 36 hrs.Called my doctor and he says I have become tolerant and to come in and we need to switch to a different drug.What drug will work best or should we add another drug to stop going into withdrawal?Kind of lost ! Kind of scared. Why would this occur? Any suggestions what is best action to take? Thanks for any and all help.

Post Edited (Stills) : 10/24/2014 2:52:10 AM (GMT-6)

Posted 10/24/2014 10:22 AM (GMT 0)
Hey Stills.Welcome to HW.
A lot of Posters here use Fentynal with good results.Most if not all change the patch every 48 hours.

I've never used Fentynal myself.I take Opana ER and Dilaudid for BT with great success.

Again,welcome.There are others more knowledgeable than me here.

Rick

Posted 10/24/2014 2:23 PM (GMT 0)
Hello Stills & welcome to the chronic pain forum. Wow, you are on a hefty dose of Fentanyl. I am not surprised at all that your tolerance has kicked in. This is something we have to deal with when on any medication long term. This applies to pretty much any type of medication taken long term. This has happened with me in the past not only with my pain meds but blood pressure medications which I have been on since I was 28 yrs old.

Your dr is the expert here on what he can put you on. What may work for one person's pain may have no effect at all on the next person. There are many, many different pain medications used to treat chronic pain & usually it is a combination of meds. I am sure that he will put on something that is an extended release with something else to take for break through pain. None of us can say what you will need to be tried on because he will have to work with the dosage to prevent you from going into withdrawals, so work with your dr on this. Raising the Fentanyl dose would not be a good idea at all let alone adding another medication to it. It is time to start with something new at this point.

Do you have an appt with the dr? If not, I would call & talk to the nurse to get you in as quick as possible. I would imagine the dr will need to see you because he cannot just call in these pain meds. Be sure to take whatever patches you have left over to the drs office.

Keep us posted & seriously work with your dr on this he should take care of you. Above all try not to stress over this, that will not help your pain levels at all. Take care.
Posted 10/24/2014 5:04 PM (GMT 0)
I've gone through withdrawl after 24 hours on only 50mcg of Fentanyl.  At your level I don't know what pill dose you'd need to touch 250mcg of Fentanyl on a daily basis.  Your downfall of all this was getting it increased.  Not that you didn't need it.  I don't think I'd go to 75mcg since I experienced withdrawl at 50.

Let us know what you Dr. does. 

Posted 10/25/2014 1:10 AM (GMT 0)
Hi everyone.....thank you all for posting back quickly.Very much appreciate it.Sorry for the book-long post but I think most of you know what withdrawal feels like..I guess I'll let you all know on Monday.I should have mentioned I was in Canada so I'm not very pleased that this is happening.It's a different system here. I could go on and on but this isn't a chat box so I will leave it at that. Thank you all for the advice and knowledge! All of the replies were alot of help. I'll keep you posted when or if able. Stills
Posted 10/25/2014 1:39 AM (GMT 0)
I wouldn't go for increase but rather changing it every 48 versus 72 hours. That seems to be what works better rather then dosing up to that level of Med. Like someone stated that's a hefty dose and I'm afraid whatever he tries to switch you to is not going to come close to 300 mcg of fent without being lethal therefore your looking at even more withdrawal issues.
Posted 10/25/2014 2:23 AM (GMT 0)
Vickie.....your post has me even more worried what's happening than ever.This has never happened to me before and hated these patches from the start.After 25 years of chronic neuropathy pain where does one go from here? Your saying you dont think there is anything that will touch 300mcgs. fentanyl ?? I really appreciate any help.Are there any options like should I go back to 250mcgs?

Post Edited (Stills) : 10/24/2014 9:06:14 PM (GMT-6)

Posted 10/25/2014 4:26 AM (GMT 0)
That is an extremely high dose. It would seem that Fentanyl might not be the med for you with all those increases. There are many other pain meds, ones your system is not used to. Each med is different for each person, so it's hard to give a recommendation. It might be trial and error.

It might be a good thing switching up meds. You are on very high doses. If something happened where you have pain above and beyond what you normally have, it would be hard to treat. I was on high doses of pain meds before my TMJ replacement surgery. I worked with my drs to switch meds up and to get to a lower dose for a few weeks. Not fun, not fun at all. But, after surgery, pain was easier to control.

Switching every 48hrs is also an option, like others have said. I take 50mcg every 48hrs. I also take a number of other meds as well. Never will be pain free, but free enough to try and have good days.

Definitely talk to your Dr. I still suspect that Fentanyl isn't the med for you. You are not getting pain relief and you deserve to. Let us know what your Dr decides.
Posted 10/27/2014 3:57 PM (GMT 0)
Hi Stills,
I'm wondering what your plan is, not you PMs, but your own. I got up to 125 mcg of Fentanyl before I decided that it wasn't the drug for me, my reflexes were so shot that I had to give up driving and it seemed as though mt BTP med, Oxy 30s, were doing the pain relief job more than the Fen was. It took me 4 months of tapering with the Oxy 30 s as pain relief and WD backup to get off the fentAnyl completely. Now I am driving again and, physically and mentally, feeling a whole lot better. My current pain meds are OxyIR 30, 3 a day and Fentora, 600 mcg, 4 a day. I've been on this regimen for 3.5 years now and it suits me fine.

I feel that the patient needs to have a clear plan for his meds in mind before he starts changing his regimen, the PM can only know your pain so much, the rest is left up to you . . . Q
Posted 10/27/2014 5:47 PM (GMT 0)
It's time to taper down the Fentanyl by going to 200mcg to every 48 hours. Then a few months later 150mcg, etc. Along with that you'll need a break through medication to fill the gap. Most likely an extended release like OxyIR or Opana in a high dose for now. It's a touchy situation because of how high your current dose is. We can only suggest but it's up to your Doctor.
Posted 10/27/2014 6:54 PM (GMT 0)
Stills, you say you have neuropathy type pain. Have you tried any of the medications like Neurotin, Lyrica, Nortriptiline, Cymbalta or Amitriptiline? These are medications used frequnetly here for nerve type pain & many have success because of narcotics not being all that effective for nerve pain. If your pain is nerve generated maybe your dr needs to add one of these medications, just a thought.
Posted 10/31/2014 2:37 AM (GMT 0)
Hello Stills.

Welcome. wow...thats really a high dose. I had the patch in the past, but the highest I had was 75mg. Have you ever thought about the pain pump??

I have my Fentynal meds in the pump, going straight to the spinal canal. Maybe something to think about....feel better.
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